Saving lives during childbirth in rural Liberia

Tackling one of the highest maternal mortality ratios in the world

By Yulia Widiati
One of the 19 four-wheel drive ambulances donated by UNICEF
UNICEF Liberia/2016
12 May 2016

Liberia’s maternal mortality ratio is one of the highest in the world, with 1,072 maternal deaths for every 100,000 births. Learn how in one rural community, UNICEF-supported trainings on home-based maternal and newborn care saved the lives of a mother and her baby.

KONOBO, Liberia, 12 May 2016 – Deep in the heart of Grand Gedeh County, Liberia, a newborn baby lies on a bed in the Konobo rural health centre. She is wrapped in a red and black lappa – a traditional Liberian cloth – and nurses and midwives come over periodically to check on her.

A nurse explains to me that she was not breathing after birth and had to be resuscitated. Being a doctor myself, I know how crucial these first golden minutes of a baby’s life are. While positioning the stethoscope on her little body, I listen to her heartbeat. I breathe a sigh of relief – her heartrate is a stable 110 beats per minute.

The baby’s mother lies close by, but she is bleeding and in great pain. She had a retained placenta after giving birth, and all attempts at helping her are failing. Suddenly, she collapses, suffering from shock. The nurses and midwives manage to resuscitate and stabilize her, but they decide to transfer her and her baby to the better-equipped main hospital in the county capital Zwedru, where they will receive advanced care.

The Konobo health centre is more than 50 kilometres from the nearest hospital, reachable only by a rugged, unpaved road. Even four-wheel drive vehicles have difficulty navigating these roads during the dry season, but access is even harder during Liberia’s six-month-long rainy season, when the roads turn to soggy mud and ensnare most vehicles. Luckily, an ambulance is available and the mother is quickly transported to the hospital with her baby, where the medical team are able to remove the remaining placenta and give her a blood transfusion. The baby is given oxygen, and both are checked on regularly. Both survive.

Reversing the trends in maternal mortality

This is just one instance in which quick action and skilled medical personnel are able to save the lives of mothers and newborns. While this may sound routine in many parts of the world, it is unfortunately not as common in rural Liberia. With 1,072 maternal deaths for every 100,000 births, Liberia has one of the highest maternal mortality ratios in the world. Haemorrhage is the leading cause of maternal deaths (25 per cent). The neonatal mortality rate is 26 for every 1,000 live births, and one in every 11 Liberian children dies before reaching her or his fifth birthday. Moreover, children in rural areas are more likely to die young compared to children in urban areas.

UNICEF is working to reverse these trends by collaborating with the Government of Liberia and other partners to increase access and availability of high quality and cost-effective health care for mothers and babies. In partnership with the Ministry of Health and County Health Teams, UNICEF is conducting trainings on home-based maternal and newborn care and on helping babies survive. Participants include almost 550 Trained Traditional Midwife (TTM) and general Community Health Volunteers (gCHVs) in Grand Gedeh, Maryland, and Sinoe Counties – some of the most underserved areas of Liberia.

Transferring the patient with an ambulance
UNICEF Liberia/2016
A mother and her newborn baby are lifted into an ambulance. Her pregnancy was high-risk, but thanks to early action by a midwife in her community, her life and her baby were both saved. She was able to give birth at a rural health centre and was then transferred to a better-equipped county hospital when she presented complications.

The training sessions focus on building the skills of gCHVs to identify pregnant women in the community, and then encouraging them to get timely antenatal care and to give birth in health facilities, where trained health care personnel can provide appropriate care, like the mother and child in Grand Gedeh. These TTMs and gCHVs also promote postnatal care and exclusive breastfeeding, and identify danger signs in mothers and babies so they can be quickly referred to health facilities.

In addition to the trainings, UNICEF donated 19 four-wheel drive ambulances to support the transferral of maternal, newborn and child emergency cases from rural, hard-to-reach clinics to larger hospitals for more advanced care. It was one of these UNICEF-donated ambulances that helped transport the mother and baby from the Konobo rural health centre to the main hospital in Zwedru.

Saving lives through early action

The next day, we visit the mother and daughter at the hospital. She is able to breastfeed, and both mother and baby are doing well.

Hers was a high-risk pregnancy – she is 39 years old and this is her ninth baby. The mother was identified by a trained midwife and encouraged to seek antenatal care and to give birth at a health facility.

Early planning and training ensured the safe delivery of her baby. Had she not been identified early enough, had she not followed the midwife’s advice and given birth at a health facility with trained personnel, or had an ambulance not been available to transport her the 55 kilometres along rough terrain to a better-equipped hospital, she and her baby would not have survived.

No mother should die while giving life, and every baby has the right to survive and thrive.


UNICEF provides a wide range of support to the health sector, including supplying medications and millions of doses of vaccines every year. Following the Ebola outbreak, UNICEF has supported the recovery of the health sector, especially in some of the most vulnerable areas in the south-east of Liberia.

>>  For more on UNICEF’s work in Liberia, visit the UNICEF Liberia website and connect with UNICEF Liberia on Facebook